Last Updated on January 19, 2019 by FRCEM Intermediate

Symptoms

• colicky abdominal pain
• abdominal distension
• Nausea Vomiting
• intolerant of enteral feeding
• constipation
• absent bowel sounds

Causes for Bowel Obstruction

Large Bowel Obstruction

• Tumor (usually sigmoid carcinoma)
• Volvulus (sigmoid, cecal)
• Fecal impaction
• Benign stricture (e.g. post-operative, inflammatory bowel disease)
• Abscess

Causes for Small Bowel Obstruction

• Adhesions (postoperative)
• intussusception(paediatric group)
• Hernias (external)
• Malignancy (peritoneal)
• Crohn disease

Functional causes

• Hypokalaemia
• Hyponatremia
• Hypothermia
• Hypoxia
• Diabetic ketoacidosis
• Uraemia
• Drugs (eg anticholinergics)
• General anesthesia
• Dehydration
• Sepsis (acute pancreatits)
• Trauma (head injury, spinal injury, pelvic surgery)
• Intra-abdominal infection / peritonitis
• Postoperative (ileus)

Investigations

• Blood tests FBC, U+Es, LFTs, glucose, amylase, group and save. Clotting screen if septic or on anticoagulants
• Plain film x-ray erect chest x-ray and supine abdominal x-ray
• ECG
• ABG if signs of sepsis or strangulated bowel
• Urinalysis

Specific Imaging

• CT
• Small bowel follow-through
• Water-soluble contrast enema

X-ray Finding

Small Bowel

• dilated bowel loops that are central (>3cm in diameter)
• the valvulae conniventes

Large bowel

• dilated bowel loops that are peripheral(dilatation to 6cm)
• contain haustra and contain faeces.

Management in ED

• Insert an IV cannula taking and send blood for FBC, U+Es, LFTs, Lactate, glucose, amylase, group and save
• Start an IV 1l of 0.9% Saline
• O2 and fluid resuscitation if the patient is haemodynamically unstable
• Move the patient to an appropriate area of the department and involve an ED senior in their management
• Titrate IV analgesia with an antiemetic
• Insert a naso-gastric tube and declare the patient nil by mouth (NBM)
• Insert a urinary catheter
• REFER TO THE SURGICAL TEAM

Treatment

• decompressionn using a colonoscopy

Complications

• Perforation
• Bowel ischaemia
• Peritonitis
• Sepsis
• Intra-abdominal abscess
• Fluid and electrolyte imbalance

More Reading
https://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/normal

Abdominal X-ray and CT